title: Reliability of a telemedicine system designed for rural Kenya.
abstract: OBJECTIVE
  Access to health care in rural areas of developing nations is hindered by both the lack of physicians and the preference of many physicians to practice in urban settings. As a result, rural patients often choose not to sacrifice wages or time to visit distant health care providers. A telemedicine system, Mashavu: Networked Health Solutions, designed to increase access to preprimary health care in rural areas, was field-tested in rural Kenya. This study aims to examine the reliability of the system compared to the traditional face-to-face method of health care delivery.
  
  
  METHODS
  Reliability of the telemedicine system was tested using a modified intraobserver concordance study. Community health workers operated the system in various remote locations. Patient health information including chief complaint, medical history, and vital statistics were sent via Internet to a consulting nurse. After patients completed the telemedicine consultation, they also met in-person with the same nurse. Subsequently, the nurse's advice during the in-person session was compared with his feedback provided through the telemedicine consultation.
  
  
  RESULTS
  When comparing the nurse's advice given through the telemedicine system with the advice given through more traditional face-to-face, in-person consultation, the nurse provided consistent medical feedback in 78.4% of the cases (n = 102). The nurse's advice regarding patient action (eg, clinical referrals or no further care necessary) was the same in 89.2% of the cases (n = 91).
  
  
  CONCLUSIONS
  The study found that this telemedicine system was able to provide patients with approximately the same quality of care and advice as if the patient had physically travelled to a clinic to see a nurse. In rural areas of developing nations where there are high logistical and economical barriers to accessing health care, this telemedicine system successfully increased the ease and lowered the cost of connecting rural patients with nurses to provide preprimary care.
authors.affiliation: The Pennsylvania State University, University Park, PA 16802, USA.
authors.forename: Rosie
authors.initials: R
authors.lastname: Qin
authors.forename: Rachel
authors.initials: R
authors.lastname: Dzombak
authors.forename: Roma
authors.initials: R
authors.lastname: Amin
authors.forename: Khanjan
authors.initials: K
authors.lastname: Mehta
mesh_terms: D003150:Community Health Workers / Q000191:economics / Q000458:organization & administration* / Q000639:trends; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration* / Q000639:trends; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D020407:Internet / Q000592:standards; D007630:Kenya; D009730:Nursing Assessment / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D015588:Observer Variation; D015203:Reproducibility of Results; D019035:Rural Health Services / Q000191:economics / Q000600:supply & distribution*; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D013997:Time Factors; D014195:Travel / Q000191:economics; D055986:Vital Signs / Q000502:physiology; D000078329:Workforce
keywords: community health; health promotion; prevention; primary care; program evaluation